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.'� . Ac R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) - 3/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certi£cate holder in lieu.of such endorsement s. PRODUCER NTA T NAME: � Britton Gallagher PHONE _ FAX _ _ One Cleveland Center, Floor 30 E-MAIL E • 1 - A/C No: 1375 East 9th Street ADDRESS: � Cleveland OH 44114 INSURER S AFFORDING COVERAGE NAIC# INSURERA:E � INSURED INSURER B:EVQ @S N8 IOf12I InSUfBnCe m n 2 Galaxy Fireworks Inc: ir,suReRc:Axis Su lus In 6620 204 E.Martin Luther King Bivd INSURER D:Tf V 1 r m rci Casualt Tampa FL 33603 ' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:793826432 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT1%VITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE DD R POLICY EFF POLICY EXP LIMITS LTR INSR VWD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY A GENERAL LIABILITY Y SI8ML00324-161 6/10/2016 6/10/2017 EpCH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY ' DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE �OCCUR MED EXP(My one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 II GEN'LAGGREGATELIMITAPPLIESPER: ' PRODUCTS-COMPlOPAGG $2,000,000 POLICY PR� X LOC $ � B AUTOMOBILE LIABILITY SI8CA00081-161 6/10/2016 6/10/2017 , Ea accident 1,000 000 X ANYAUTO BODILYINJURY(Perperson) $ ALLOWNED � SCHEDULED BODILYINJURY(Peraccident) $ AUTOS AUTOS X X NON-0WNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident �I $ C UMBRELLA LIAB X pCCUR EAU753159 6/10/2016 6/10/2017 EpCH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ p WORKERS COMPENSATION 6FR13UB-2E63702-1-16(FL) 1/19/2016 1/19/2017 X WC STATU- OTH- AND EMPLOYERS'LIABILITY �,�N T ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N I A E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below �E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additlanal Remarks Schedule,if more space is requfred) Location:5953 Gall Blvd,Zephyrhills Additional Insureds:City of Zephyrhills, Mark Ayer and all his agents, representatives and subsidiaries (Workmen Comp) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. 6907 Dairy Rd Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE i�/�� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD